Clinical Features of 2019 Novel Coronavirus Pneumonia Presented Gastrointestinal Symptoms But Without Fever Onset

Background: Early detection of infected patients is one of the most important steps to mitigate spreading of 2019 novel coronavirus (2019-nCoV). Here, we report a set of atypical 2019-nCoV pneumonia cases with gastrointestinal symptoms onset but without fever or other respiratory symptoms.Methods: We retrospectively reviewed data of admitted patients of 2019-nCoV pneumonia with only digestive symptoms and no fever on the onset from January 17-24, 2019 in Renmin Hospital of Wuhan University. The patients' history, clinical features, physical findings, complete blood count, biochemical results, chest X-ray imaging, microbiological investigation and viral pathogens results were recorded and analyzed.Findings: From January 17 to 24, 2020, nine admitted patients with only digestive symptoms and no fever on the onset had been identified as 2019-nCoV infection. None of the patients had history of contact with animals or visited to the Huanan seafood wholesale market in Wuhan, while they all had exposure history of confirmed or suspected 2019-nCoV-infected patients. Six patients had anorexia (66.7%). Other symptoms include nausea, vomit and diarrhea. All presented digestive symptoms occurred 1-3 days (median time: 2.1 days) before the patients' visit. None of the cases had fever on onset while 5 patients occurred fever and/or respiratory symptoms 2-5 days after initial non-specific presentations. Other 4 patients never presented respiratory symptoms or fever in the following admissions. Pulmonary infiltrates including multifocal patchy ground-glass opacities were detected on CT scans in all cases at the day of their first clinic visit. All nine patients were admitted to hospital under isolation, supportive care, remained stable and none of them was transferred to ICU as of Feb 2, 2020.Interpretation: Patients with recent gastrointestinal symptoms as well as confirmed or suspected 2019-nCoV pneumonia exposure history are potential 2019-nCoV pneumonia candidates. It is significant to take atypical symptoms into account to avoid missed diagnosis, and important for gastroenterologists to strengthen protection to avoid possible infection.Funding: Project of Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision (Grant No. 2018BCC337); Hubei Province Major Science and Technology Innovation Project (Grant No. 2018-916-000-008 to Honggang Yu); The National Natural Science Foundation of China [Grant Nos. 81672387 to Honggang Yu]; The National Natural Science Foundation of China [Grant Nos. 81302131 to Ping An]. Declaration of Interest: All authors declared no conflict of interest.Ethical Approval: The study protocol was approved by the ethics committee of Renmin Hospital of Wuhan University.